Immediate Treatment of Acute HIV in a Tertiary Healthcare Center

Bridging Gaps in Communication Using Smartphones

S Perez-Patrigeon; A Camiro-Zúñiga; MR Jaramillo-Jante; PF Belaunzarán-Zamudio; B Crabtree-Ramírez; LE Soto-Ramírez; JJ Calva; C Hernández-León; JL Mosqueda-Gómez; S Navarro-Alvarez; JG Sierra-Madero

Disclosures

HIV Medicine. 2019;20(5):308-316. 

In This Article

Results

During the study period, we identified 29 adults who met the inclusion criteria for the intervention group and 115 ART-naïve chronically infected adults in the comparison group. The intervention group consisted of 29 adults with acute HIV infection (eight patients diagnosed as being in Fiebig stage 6, five in stage 5, 10 in stage 4, one in stage 3 and five in stage 2). The baseline characteristics of both groups are described in Table 1. The sociodemographic characteristics of patients with acute HIV infection were similar to those of their counterparts in the other group. Most patients with acute HIV infection sought care as a consequence of symptoms attributed to acute retroviral syndrome. As expected, patients with acute HIV infection had a higher median CD4 count at enrolment than those with chronic infection (407.28 cells/μL versus 189.08 cells/μL, respectively; P < 0.001), a higher median CD4:CD8 ratio (0.92 versus 0.59, respectively; P < 0.001) and a higher median HIV viral load (3.07 × 106 copies/mL versus 0.68 × 106 copies/mL, respectively; P < 0.001). More patients in the acute and recent HIV infection group received integrase strand transfer inhibitor (INSTI)-based regimes (39.28% versus 17.39%, respectively; P = 0.007).

Time to ART Initiation

In the acute infection group, of the 27 patients who accepted the intervention, 14 initiated ART on the day of their first visit, six more by the end of week 1, and the remaining four by day 35. Two patients rejected the immediate initiation of ART and did not start their treatment until days 129 and 189 after enrolment, respectively. The median time to ART initiation was 2 days in the intervention group and 21 days in the comparison group (P < 0.001) (Figure 2).

Figure 2.

Time to ART initiation ART, antiretroviral therapy.

The main reasons for not initiating ART in the first 48 h in the intervention group were as follows: delay in the processing of the confirmatory or routine laboratory tests, patient preference for receiving HIV care at another centre, and patient's refusal of HIV care.

Secondary Outcomes

Three patients in the chronic group and one patient in the acute group died during the first 2 months of ART, leaving 112 patients and 28 patients for the analyses of the 5–8 month and 9–12 month time bins. The proportion of patients engaged in care, receiving ART, or with virological suppression at 4, 8 and 12 months after enrolment did not differ significantly between groups (Figure 3).

Figure 3.

Evaluation of continuum of care - Acute HIV infection vs. Chronic HIV infection

Comparison of Immediate Initiators Versus Nonimmediate Initiators

Fifteen patients in the acute group (52%) and nine patients in the chronic group (8%) started ART in < 48 h. When comparing the immediate ART initiation group with the nonimmediate ART group, there were no significant differences in engagement in care, ART initiation or viral suppression in any of the time bins (Figure 4).

Figure 4.

Evaluation of continuum of care - Immediate ART initiation vs. Non-immediate ART initiation

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